Medicaid / PCAP vs. Employer Insurance Question

I have a complicated insurance issue, but I am hoping someone else has experience with this. So here's my situation:

I was uninsured and in between jobs when I found out I was pregnant. I applied for Medicaid / PCAP. While I have not yet received my card, I was told I was definitely eligible.

A few weeks after applying, I was offered a job. Here are the details about the job:

I would be making pretty close to the maximum for Medicaid / PCAP. Some months I might be slightly over (but not until I finish a 2-month probationary period).

The employer offers health insurance. I have no idea what plan or policy they use. I also don't know how much I would have to pay, or what it covers. I would not be able to join for a couple months.

So my questions are. . .

Can a group insurance policy refuse to cover me or my pregnancy because it's a pre-existing condition? I have read conflicting reports.

Can an employer require me to join their health plan?

Do employer-sponsored group health insurance policies usually allow you to choose between plans, HMOs, etc.? I've never had insurance through work!

Could I keep my Medicaid / PCAP if I become eligible for insurance offered by my employer during my 4th month of pregnancy?

I ask because I am concerned that my employer's health insurance will end up costing me a lot of money and / or not covering the providers I want to see. So even though I would be making a little more money at this job, I might end up broker than if I had just accepted a PT job with no benefits and kept PCAP.

Does anyone have experience with this? Any help would be appreciated!

Hey all,

I have a complicated insurance issue, but I am hoping someone else has experience with this. So here's my situation:

I was uninsured and in between jobs when I found out I was pregnant. I applied for Medicaid / PCAP. While I have not yet received my card, I was told I was definitely eligible.

A few weeks after applying, I was offered a job. Here are the details about the job:

I would be making pretty close to the maximum for Medicaid / PCAP. Some months I might be slightly over (but not until I finish a 2-month probationary period).

The employer offers health insurance. I have no idea what plan or policy they use. I also don't know how much I would have to pay, or what it covers. I would not be able to join for a couple months.

So my questions are. . .

Can a group insurance policy refuse to cover me or my pregnancy because it's a pre-existing condition? I have read conflicting reports.

Can an employer require me to join their health plan?

Do employer-sponsored group health insurance policies usually allow you to choose between plans, HMOs, etc.? I've never had insurance through work!

Could I keep my Medicaid / PCAP if I become eligible for insurance offered by my employer during my 4th month of pregnancy?

I ask because I am concerned that my employer's health insurance will end up costing me a lot of money and / or not covering the providers I want to see. So even though I would be making a little more money at this job, I might end up broker than if I had just accepted a PT job with no benefits and kept PCAP.

Sorry only have two answers for you - no, your employer cannot force you to use their plan but i do think you have to say where you are getting insurance from. The plans available will vary by employer. You should ask HR for this information even if it's not happening yet so that you can evaluate as yes sometimes insurance deductibles can be high. I had my baby last year and was fully covered. I paid $25 for the initial OB visit. My employer just switched insurance plans and if I have a baby now I have a $5,700 deductible.

Sorry only have two answers for you - no, your employer cannot force you to use their plan but i do think you have to say where you are getting insurance from. The plans available will vary by employer. You should ask HR for this information even if it's not happening yet so that you can evaluate as yes sometimes insurance deductibles can be high. I had my baby last year and was fully covered. I paid $25 for the initial OB visit. My employer just switched insurance plans and if I have a baby now I have a $5,700 deductible.

You definitely need to speak with your hr coordinator at your new job and clarify the details of your coverage. With pe-cap and medicaid you are fully covered the benefits are great. However Medicaid has been getting a bit smart lately and if you are covered by your employer and they find out they will seek reimbursement from you. You might be able to decline your employers insurance and keep the medicaid, if your income is over the Medicaid threshold you can have a spend down, where u show your expenses and that should take of the extra income. Good luck.

Hi

You definitely need to speak with your hr coordinator at your new job and clarify the details of your coverage. With pe-cap and medicaid you are fully covered the benefits are great. However Medicaid has been getting a bit smart lately and if you are covered by your employer and they find out they will seek reimbursement from you. You might be able to decline your employers insurance and keep the medicaid, if your income is over the Medicaid threshold you can have a spend down, where u show your expenses and that should take of the extra income. Good luck.

I cannot answer all your questions but can tell you this. You cannot receive Medicaid when you have other insurance available to you. Also the person who mentioned a spenddown that is only if you are disabled. You would need to be collecting Ssd or declared disabled by New York state. Good luck

I cannot answer all your questions but can tell you this. You cannot receive Medicaid when you have other insurance available to you. Also the person who mentioned a spenddown that is only if you are disabled. You would need to be collecting Ssd or declared disabled by New York state. Good luck

Hi Becca- so you are automatically disqualified for Medicaid if your employer offers insurance? Is this definitely true for PCAP (pregnancy)?

I have been trying to find that information online. I haven't been able to find a definitive answer, but I did find a few sources saying some people are be eligible for PCAP even if they have other insurance. I also took a survey online and it said I would still be eligible for PCAP if the monthly premium on my employer's insurance is over a certain amount.

Who knows how accurate any of that information is, though! I wish I could get a clear answer, I am starting to think I might have done better to accept the job that didn't offer any benefits! I will still be struggling to save up for my disability leave and baby-related costs, and it will be really difficult to pay a high monthly premium or a high deductible.

Unfortunately, the job is for a tiny organization that doesn't have an HR department. I would rather meet confidentially with someone in HR first, but I would have to go straight to my boss for this information and he doesn't know I'm pregnant yet.

Hi Becca- so you are automatically disqualified for Medicaid if your employer offers insurance? Is this definitely true for PCAP (pregnancy)?

I have been trying to find that information online. I haven't been able to find a definitive answer, but I did find a few sources saying some people are be eligible for PCAP even if they have other insurance. I also took a survey online and it said I would still be eligible for PCAP if the monthly premium on my employer's insurance is over a certain amount.

Who knows how accurate any of that information is, though! I wish I could get a clear answer, I am starting to think I might have done better to accept the job that didn't offer any benefits! I will still be struggling to save up for my disability leave and baby-related costs, and it will be really difficult to pay a high monthly premium or a high deductible.

Unfortunately, the job is for a tiny organization that doesn't have an HR department. I would rather meet confidentially with someone in HR first, but I would have to go straight to my boss for this information and he doesn't know I'm pregnant yet.

You may qualify for PCAP. Since I am on maternity leave I can't look it up for you. The premium sounds right. Are I in NYC or the suburbs. Call your worker. Medicaid is retro scribe three months from the date u apply. Sorry I can't be more help.

You may qualify for PCAP. Since I am on maternity leave I can't look it up for you. The premium sounds right. Are I in NYC or the suburbs. Call your worker. Medicaid is retro scribe three months from the date u apply. Sorry I can't be more help.

I think you should just apply for the PCAP..you don't have to pay anything..and you don't even know if your employer insurance covers pregnancy at all..and by the time you find that out you still need to go to doc visits..my husband has private insurance but I have Medicaid for me and my daughter because we couldn't afford the deductibles and co pays..good luck

I think you should just apply for the PCAP..you don't have to pay anything..and you don't even know if your employer insurance covers pregnancy at all..and by the time you find that out you still need to go to doc visits..my husband has private insurance but I have Medicaid for me and my daughter because we couldn't afford the deductibles and co pays..good luck

The material on this website is provided for educational purposes only and is not to be used for medical advice, diagnosis, or treatment, or in place of therapy or medical care. Use of this site is subject to our terms of use and privacy policy

Advertising Notice

This Site and third parties who place advertisements on this Site may collect and use information about your visits to this Site and other websites in order to provide advertisements about goods and services of interest to you. If you would like to obtain more information about these advertising practices and to make choices about online behavioral advertising, please click here